tsj98

[tsj98]

3 months ago I stopped my period and had started ahving night sweats.  My gyn tested my FSH,LH and estrodial.  FSH came back at 146, LH came back at 101 and estradial <15.  It is thought that I went into premature ovarian failure.  August 1 i began HRT with estrogel and Prometrium the ist 10 days of the month.    I only have 1 ovary as the other was removed 20 years ago for a dermoid tumor.  I ahd a bone density test done and it showed early osteopenia in my left hip.  I had an ultrasound done in November 06 that showed a normal ovary other then a simple cyst. and no signs of menopause.  In April 07 I had my last period.  I have had right sided abdominal pain for 6 months and also in the back.  Feelings of fatigue and some pains down my leg. I began bleeding on day 7 of this month, 3 days prior to finishing the cyclical dose of Prometrium.  I had a CT scan on the day I began the bleeding that  showed what the radiologist said was a 2.7cm right adnexal hypodensity which could represent a ovarian cyst.  Fluid in the endometrial cavity and a fundal patchy enhancement with a 4cm superior rounded prominence, possibly a fibroid.  It was also stated that if I was post menopausal (which I appear to be) it could be abnormal since my ovary is non functioning and my FSH, LH are so high and my estrodial is <15.  I have only been on HRT for 13 days.  A CA-125 was done and was within normal limits.My question is: SHould I be worried about Ovarian Cancer and is a CT scan better at detecting masses then Ultrasound?  I had an Ultrasound in June and it supposedly showed nothing other then my ovary was very small (thought to be because of early menopause).  What steps should I take from here?

[tsj98]

Dr. Seibel - thanks for your response.  here is an update since August.  I have had two periods after having 4 months of none with my FSH at 146, LH 101 and estradial<15.  Now my FSH is down to 12 and my estradial at 88.  After having the CT scan showing the cyst and possible fibroid an ultrasound was done.  It showed a cyst on my ovary, a cyst to the side of it and a tumor in the uterus.  During this process over the last 6-8 months my RBC and hemoglobin have been low along with my Ferritin low also when i did not even have a period for several months of this time.  MY white blood cell count has also been low.  My PAP in June was ASCUS.  This is the first time I have ever had an abnormal PAP.  The HPV, however, came back negative.  What should I be concerned about?  Could the cysts appear simple now but change and should I be concerned about the tumor in my ovary given my blood work results over the last 6-8 months.  

[Machelle Seibel, MD]

It does sound like you are in menopause from your blood tests. Dermoid cysts are found in the other ovary in about 20% of cases so there could be one on the remaining ovary. However, dermoids are usually increased density, not low density which is what yours showed. While it is not possible to say for certain, it seems that your ultrasound was normal and the CT which is able to see more, has a question of a cyst. It does not sound like cancer here, though it cannot be said with absolute certainty with this information.

The best thing to do is to just have ultrasound follow up every 3 to 4 months for a year and repeat the CT either in a year or if the ultrasound changes. Talk about this plan with your doctor and try to work out something along these lines just to be on the safe side.
Machelle M. Seibel, MD